Aims Guidelines for different respiratory conditions in children give variable recommendations for permissive hypoxaemia and for target oxygen levels which mandate the commencement of oxygen therapy. This has the potential to cause confusion for clinical staff regarding when to initiate oxygen therapy during a child’s initial assessment. We have reviewed the evidence behind the guidelines to assess its strength with the aim of offering a standard recommendation that can be used irrespective of the underlying diagnosis.
Methods A search for all English language guidelines published between 2005–2015 on bronchiolitis, asthma, lower respiratory tract infections and viral wheeze was undertaken, specifically extracting the evidence behind their permissive hypoxaemia recommendations. We also performed a literature review using Pubmed between 2005–2015 to ascertain if any new evidence had become available.
Results The guideline recommendations were largely based on consensus opinion with saturations from 92–94% given as the appropriate point at which to start oxygen therapy.
The American Academy of Paediatrics recommends 90% in bronchiolitis in accordance with WHO guidelines.1 A literature search revealed one recently published randomised control trial which found that, in those with permissive hypoxaemia targets of 90%, there were lower rates of readmission when compared with targets of 94% suggesting no detrimental outcome to children with bronchiolitis being allowed saturations this low without supplemental oxygen.2
Conclusion There is very little high quality evidence for safe levels in hypoxaemia but a standardised level of 92% for all respiratory conditions in children appears safe whilst more evidence is awaited.
American Academy of Pediatrics. Diagnosis and management of bronchiolitis. Pediatrics 2006;118:1774–93
Cunningham S, Rodriguez A, Adams T, et al. Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. Lancet 2015;386:1041–8
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